Geographic Distance to Care and Financial Toxicity During Pediatric Cancer Treatment: A Qualitative Framework Analysis

BACKGROUND: Families of children with cancer often experience financial toxicity resulting from cancer care. Pediatric patients living in geographically remote locations face unique barriers to access centralized subspecialty medical and support services, potentially worsening financial toxicity. METHODS: We conducted in-depth semi-structured interviews, in English and Spanish, with a purposive sample of adult caregivers of children treated for cancer. We characterized caregivers as geographically distant or proximal based on travel time from their permanent residence, using a cutoff of 60 min. We performed a framework analysis of interview transcripts focused on exploring how geographic distance to care shaped lived experiences with financial toxicity and its subsequent effects on patients and families. RESULTS: We interviewed 21 caregivers, 14 (67%) of whom were geographically distant. Distance to care was reported as provoking or exacerbating financial toxicity by most geographically distant families (13/14). Three primary themes emerged that were particularly salient for geographically distant versus proximal families: (i) difficulty maintaining income driven by challenging logistics and temporary relocation for care; (ii) increased household spending related to travel and housing; (iii) altered or diminished capacity to respond to financial toxicity. CONCLUSION: Families of children with cancer perceived geographic distance to care as an important factor that intensified financial toxicity. Interventions are needed to mitigate the development and effects of financial toxicity, and geographically distant families may require supplementary solutions tailored to their specific support needs.